POS0596-HPR GOUT PATIENTS’ PERSPECTIVE ON CONTINUATION OR DISCONTINUATION OF URATE-LOWERING THERAPY WHEN REMISSION HAS BEEN ACHIEVED: A MIXED METHODS STUDY
Authors: I. R. Peeters, F. Veenstra, J. E. Vriezekolk, C. Van den Ende, A. Den Broeder, S. A. C. Wanten, N. Van Herwaarden, L. M. Verhoef, M. Flendrie
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Long-term gout management is based on reducing serum urate by using urate-lowering therapy (ULT) [1, 2]. A lifelong treat-to-target approach is advocated, though a ULT (taper to) stop attempt can be considered (treat-to-avoid symptoms approach) during remission[1]. It is yet unclear if either is a superior strategy when remission has been achieved. Exploring gout patients' beliefs on these long-term ULT strategies is important for optimising gout management. <h3>Objectives</h3> To identify factors that influence the decision for continuation (treat-to-target) or discontinuation (treat-to-avoid symptoms) of ULT and to determine their perceived relative importance in gout patients in remission. <h3>Methods</h3> A mixed methods design was used. First, semi-structured interviews (substudy 1 EULAR POS1477 2020) were held to identify barriers and facilitators for continuation and discontinuation of ULT using inductive thematic analysis. These items were then summarized by a multidisciplinary team (including a patient partner) in neutrally formulated items. These items were subsequently used in a Maximum Difference Scaling study (MaxDiff, substudy 2) to rank them and to determine their relative importance based on utility scores (preference score). A rescaled probability score (RPS) was generated with a 0-100 range (the higher the score, the more important the item). For example, an item with an RPS of 8 is twice as important as an item with an RPS of 4. Patients of both studies were recruited from general practitioners and from the rheumatology department of the Sint Maartenskliniek (both in the Netherlands). The semi-structurered interviews as well as the MaxDiff experiment have been pilot tested. <h3>Results</h3> Substudy 1 and 2 included 18 and 156 patients, respectively (see Table 1). The semi-structured interviews yielded 46 barriers/ facilitators and were summarized in 22 items, divided into 10 overarching themes (logistics, lifestyle, role of serum urate, physician role, scientific knowledge, general medication use, anti-inflammatory use, gout flares, ULT use and long-term gout effects). Figure 1 shows their ranking (substudy 2). The 'risk of joint damage' (RPS 8.77) was the most important item, and is 26 times more important than the least important item, 'cost of my gout treatment' (RPS 0.34). <h3>Conclusion</h3> In particular, items concerning (control of) disease activity (flares, joint damage) play a role when gout patients in remission consider (dis)continuation of ULT. Costs, logistics and monitoring by physician were deemed less important. These results provide a basis for shared decision making between physicians and patients, and show which items should at least be discussed when considering ULT (dis)continuation in the remission phase. <h3>References</h3> [1]FitzGerald, J.D., et al., <i>2020 American College of Rheumatology Guideline for the Management of Gout.</i> Arthritis Care Res (Hoboken), 2020. <b>72</b>(6): p. 744-760. [2]Richette, P., et al., <i>2016 updated EULAR evidence-based recommendations for the management of gout.</i> Ann Rheum Dis, 2017. <b>76</b>(1): p. 29-42. Relative importance of the 22 items based on their rescaled probability score (RPS). ULT; urate lowering therapy. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.